Introduction: Cleft Lip and Palate is the most common craniofacial anomaly, and cleft lip and palate repair is widely performed. Alveolar cleft accompanies 75% of cleft lip cases and requires alveolar bone graft (ABG) surgery at mixed dentition age. However, studies on rates of ABG surgery are scarce. Objective: This study aims to investigate the low popularity of ABG and orthodontic care among patients with ABG history at Cleft and Craniofacial Centre, Cipto Mangunkusumo Hospital, Jakarta. Method: A total of 771 patients had orofacial cleft surgeries throughout 2015 to 2021. A descriptive analysis of labioplasty, palatoplasty, and ABG surgeries was presented. Questionnaire-based qualitative analysis of ABG was obtained from the patient’s guardians to evaluate the limitation and experience of conducting the surgery at our institution. Results: We distributed questionnaires to 13 patients with a history of ABG. ABG accounted for only 5% of total orofacial cleft surgeries. The average age of ABG surgery and orthodontic care initiation was 11 and 11.8 years old, respectively. About 82% had access to preoperative and postoperative orthodontic care; however, only 11% received PSO before 9 years old. The satisfaction rate was 100% and 75% in ABG patients with and without orthodontic care, respectively, reporting improved feeding, speech, teeth alignment, and esthetic result. Conclusion: Orofacial cleft management requires a multistage, comprehensive, and multidisciplinary approach. The number of ABG surgeries is low in developing countries, attributed to unequal access to ABG and orthodontic care, suggesting that limitations of knowledge, geography, and economy play a big role in Indonesian healthcare.

Background: The number of breast augmentation in Indonesia has been raised, especially in young women. Women with disorders of sex development (DSD) can be one of our patients that come for breast augmentation. These patients may also have other problems that can lead to serious disease in her later life, such as malignancies which has 30% probability.Patients and Methods: We report one case of female with 46 XY karyotype and normal female phenotype. She appeared to be normal female but did not develop secondary sexual characteristics at puberty with Tanner classi!cation M1P1, did not menstruate, and had streak gonads in ovarian localization. This gonadal dysgenesis syndrome is also called Swyer syndrome.Result: A clinical team consists of plastic surgeons, gynecologist, psychiatrist, geneticist was build to manage our patient comprehensively. We performed breast augmentation, laparoscopic gonadectomy, and psychological support.Summary: Patient with disorder of sex development (DSD) can be one of our patients who come for breast augmentation. One must pay attention to subtle sign leading to DSD patients such as, history of amenorrhea, wide chest and lack of women body curve. Complete evaluation of sexual development is needed before performing breast augmentation.

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.